title: A preoperative neutrophil to lymphocyte ratio of 3 predicts disease-free survival after curative elective colorectal cancer surgery.
abstract: OBJECTIVE
  This study aims to determine the role of the neutrophil to lymphocyte ratio (NLR) as a prognostic marker for patients with nonmetastatic colorectal cancer undergoing curative resection.
  
  
  BACKGROUND
  An NLR reflects a systematic inflammatory response, with some evidence suggesting that an elevated preoperative NLR of more than 5.0 is associated with poorer survival in patients with colorectal cancer.
  
  
  METHODS
  Data from 506 consecutive patients with a diagnosis of nonmetastatic colorectal adenocarcinoma undergoing surgical resection between 2006 and 2011 were included. Receiver operating characteristic curve analysis was used to identify the optimal value for NLR in relation to disease-free and overall survival. Univariate and multivariate Cox regression models were used to determine the role of NLR after stratification by several clinicopathological factors. Patients were followed by a standardized protocol until February 2013.
  
  
  RESULTS
  Median follow-up was 45 months [interquartile range, 21-65]. Multivariate Cox regression analysis identified an NLR of more than 3 as an independent prognostic factor for disease-free survival (odds ratio = 2.41; 95% confidence interval = 1.12-5.15; P = 0.024) but not for overall survival (odds ratio = 1.23; 95% confidence interval = 0.80-1.90; P = 0.347). A high NLR was significantly associated with older age, higher T and N stages, the presence of microvascular invasion, low preoperative albumin levels, and higher ASA (American Society of Anesthesiologists) status of the patient.
  
  
  CONCLUSIONS
  For patients with colorectal cancer, a preoperative NLR of more than 3.0 may be an independent prognostic factor for disease-free survival. Considering this in addition to well-established prognostic variables may improve the processes of identifying patients at higher risk of recurrence who would benefit from adjuvant therapies or more frequent surveillance, thereby providing more personalized cancer care.
authors.affiliation: From the Department of Surgery, St. Mark's Hospital, London, United Kingdom.
authors.forename: George
authors.initials: G
authors.lastname: Malietzis
authors.forename: Marco
authors.initials: M
authors.lastname: Giacometti
authors.forename: Alan
authors.initials: A
authors.lastname: Askari
authors.forename: Subramanian
authors.initials: S
authors.lastname: Nachiappan
authors.forename: Robin H
authors.initials: RH
authors.lastname: Kennedy
authors.forename: Omar D
authors.initials: OD
authors.lastname: Faiz
authors.forename: Omer
authors.initials: O
authors.lastname: Aziz
authors.forename: John T
authors.initials: JT
authors.lastname: Jenkins
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000097:blood* / Q000601:surgery*; D018572:Disease-Free Survival; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome